APPLICATION FORM: GREAT NOTH RUN 2016
(Please tick) I would like to apply for a place in The Great North Run 2016 and I pledge to raise a minimum of £500 in sponsorship for PSC Support.
Name:
Address:
Postcode: Tel:
Email:
Date of birth:
Are you happy for PSC Support to contact you via email? YES/NO (delete as applicable)
How did you hear about PSC Support?
Do you or someone you know have PSC? I have PSC/Someone I know has PSC (delete as applicable)
Have you run in The Great North Run before? YES/NO (delete as applicable)
If YES, which charity did you run for and when?
Have you taken part in any other distance run before? YES/NO (delete as applicable)
If YES, which events and when?
Tell us why raising money and awareness for PSC Support is important to you:
Tell us how you plan to meet your minimum sponsorship target of £500 (include ideas for fundraising events and activities, previous fundraising, and press/PR opportunities you can offer, company/employer sponsorship etc):
What is your predicted fundraising total?
What kind of help and support would you like from PSC Support during your fundraising (if any)? ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
I agree that should I receive a place for PSC Support in The Great North Run 2016, it will remain the property of PSC Support and is non-transferable. I pledge to raise a minimum of £500 for PSC Support (excluding Gift Aid). PSC Support reserves the right to withdraw my place should I not have raised or received in pledges, £350 of this amount by one week prior to the date of The Great North Run 2016.
Signature/type name:
If you have any questions: please email
Thank you for applying for a PSC Support place in The Great North Run 2016
Please email your completed Application Form by 12th October to:
Or by post to PSC Support, 3 O’Donnell Drive, Didcot, Oxfordshire OX11 6BT